Nature communications · 2025
Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion.
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Wasakul Varanya, Verschuuren Tess D, Thuy-Nhien Nguyen, Booth Ethan, Quang Huynh Hong, Thang Ngo Duc, Chindavongsa Keobouphaphone, Sovannaroth Siv, Banouvong Virasak, Sengsavath Viengphone, Mayxay Mayfong, Tuyen Nguyen Thi Kim, Phuong Vo Ngoc Lam, Duc Trung Pham, Gonçalves Sónia, Chen Soun, Phalivong Sonexay, Xayvanghang Saiamphone, Mahaphontrakoon Supaporn, Pearson Richard D, Newton Paul N, Maude Richard J, Ashley Elizabeth A, Ariani Cristina V, Simpson Victoria J, Day Nicholas P, Dondorp Arjen M, Miotto Olivo
Аннотация
Genetic surveillance of Plasmodium falciparum (Pf) can track antimalarial-resistant strains, to inform decision-making by National Malaria Control Programmes (NMCPs). The GenRe-Mekong project prospectively collected 5982 samples in the Greater Mekong Subregion (GMS) between 2017 and 2022, genotyping drug resistance markers, and barcodes that recapitulate genetic variation. Genotypes were analyzed with the grcMalaria R package, first described in this paper, to translate genetic epidemiology data into actionable visual information. Since 2020, Pf incidences decreased rapidly, accompanied by a decline of dihydroartemisinin-piperaquine (DHA-PPQ) resistant lineages, previously dominant in the eastern GMS. The frequency of plasmepsin2/3 amplifications, conferring piperaquine resistance, dropped from 62% in 2017-2019 to 2% in 2022, coinciding with a switch in frontline therapy in Cambodia, Thailand, and Vietnam. While regional artemisinin resistance levels remained high, no evidence of emerging mefloquine resistance was found. Routine genetic surveillance proved valuable in monitoring rapid parasite population changes in response to public health interventions, providing actionable information for NMCPs.